Bill > SB269

This bill aims to regulate ground ambulance services by prohibiting balance billing and establishing minimum reimbursement rates from health care insurers to emergency medical service providers, or EMS providers. Balance billing occurs when a provider bills a patient for the difference between their charge and what their insurance pays. The bill defines key terms like "covered services" (transport or medical services provided by an EMS provider that are covered by a health care benefit plan), "emergency ground transport" (transport to a hospital due to a serious medical condition), and "treat in place" (assessing and treating a patient at their location without transport). Starting October 1, 2026, insurers must contract with willing EMS providers and pay at least 200% of the Medicare Ambulance Fee Schedule rate for in-network emergency ground transport, and starting January 1, 2027, at least 180% of that rate for out-of-network services. For "treat in place" services, the minimum reimbursement will also be 200% of the Medicare rate for basic life support, but only if a claim for ground transport for the same event isn't submitted. Crucially, EMS providers, whether in-network or out-of-network, will be prohibited from billing patients for any amount beyond their standard cost-sharing (like deductibles or copays), with insurers responsible for paying the provider directly. The bill also mandates reporting requirements for both EMS providers and insurers to the Alabama Department of Public Health regarding services, finances, and claim denials, and requires a study on the impact of these provisions, with all sections set to be repealed on June 1, 2029.

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https://alison.legislature.state.al.us/bill-search